CAGE OF CONTROL
The Cage

Control of the Economy

Nearly half the economy runs through government. Now Ottawa is eyeing the steel mills.

Introduction

When people talk about government control, they usually mean speech, surveillance and the press. I think the economy matters just as much. A government that pays for your doctor, delivers your mail, sells you your electricity and your wine, and lends money to your employer has a hold on you that no censorship law could match. Canada is my first case.

Canada: government spending as a share of the economy

THE STATE

From a twentieth of the economy to nearly half.

Canada: government spending as a share of GDP, 1870–2024Canada general government spending as % of GDP: 1870 4.9%; 1880 6.8%; 1890 5.7%; 1900 6.1%; 1910 6.0%; 1920 10.5%; 1930 7.7%; 1940 18.6%; 1950 15.0%; 1960 14.9%; 1970 36.0%; 1980 41.6%; 1990 48.8%; 2000 41.1%; 2010 43.1%; 2020 52.4%; 2024 44.7%0%20%40%60%4.9%15.0%48.8%52.4%44.7%187019001930196019902024Year (every 10 years, plus 2024)

44.7%

of GDP spent by government (all levels) in 2024, up from 4.9% in 1870 and 15.0% in 1950

Chart: General government expenditure as % of GDP, from the IMF's Public Finances in Modern History database (Mauro et al.), values for every tenth year plus 2024.[1] The 1945 wartime peak (43.3%) falls between plotted points and is not shown. 2020 reflects pandemic spending. Figures cover federal, provincial and local government combined.

Canada: the state as provider

The size of it. In 1870, Canadian governments spent about 4.9% of GDP. By 1990 it was 48.8%, in 2020 it hit 52.4%, and in 2024 it was 44.7%.[1] Nearly half of everything the country produces now passes through government hands.

Healthcare. Under the Canada Health Act, provinces only get full federal health transfers if their public insurance plans are publicly administered, comprehensive, universal, portable and accessible, and the Act penalises extra billing and user charges.[2] In practice that means one payer per province for medically necessary hospital and physician care. CIHI projects total health spending of $399 billion in 2025, about $9,626 per Canadian and 12.7% of GDP.[3] What do Canadians get for it? The Fraser Institute's physician survey found a median wait of 28.6 weeks from a GP referral to treatment in 2025, the second-longest ever recorded, against 9.3 weeks in 1993. In New Brunswick it was 60.9 weeks, and an estimated 1.4 million procedures were waiting.[4] When the state is the only buyer, the queue is the price.

Crown corporations. Canada Post lost $1.57 billion before tax in 2025, its worst result ever, and has lost about $5.4 billion since 2018. In 2025 it began needing repayable federal cash injections to stay solvent.[5] The CBC received an estimated $1.38 billion in 2024–25.[6] Beyond those, a long list of businesses is owned by Ottawa or the provinces: passenger rail, big provincial power utilities such as Hydro-Québec and BC Hydro, and provincial liquor boards that control alcohol sales. [Needs source: ownership, size and monopoly status of VIA Rail, Hydro-Québec, BC Hydro and provincial liquor boards such as the LCBO.]

Steel: the state steps in

Algoma. The first loan under Ottawa's new Large Enterprise Tariff Loan facility went to Algoma Steel in Sault Ste. Marie: $400 million from the federal government's emergency lending arm and $100 million from Ontario, completed in November 2025.[7][8] In return, the governments received 6.77 million warrants to buy Algoma shares.[8] The facility carries a condition the government itself describes as "requiring companies to prioritize worker retention."[9] Taxpayer money comes with strings, and those strings run to Ottawa.

Stelco. When U.S.-based Cleveland-Cliffs bought Stelco in 2024, Ottawa imposed legally binding conditions, including keeping its unionized workforce in Canada for five years.[10] When Cliffs moved to lay off up to 500 workers in Hamilton, Industry Minister Mélanie Joly threatened financial penalties or a forced sale: "Everything is on the table."[11] On 16 October 2026 she said Canada is exploring all options under the Investment Canada Act, and Reuters reported it as Ottawa exploring nationalising Stelco.[12] She did not rule out the government taking a stake.[13]

Cleveland-Cliffs chief executive Lourenco Goncalves answered by pointing to Venezuela. In an interview reported by The Globe and Mail on 7 October 2026, he cited Hugo Chávez's 2008 nationalisation of the steelmaker SIDOR, a takeover widely seen as an economic disaster, and asked:[10]

“Is that what Canada really wants to do?”
— Lourenco Goncalves, CEO of Cleveland-Cliffs, Stelco's owner, on Chávez's takeover of SIDOR (The Globe and Mail, 7 Oct 2026)

I'm no fan of Goncalves. He backed the tariffs that hurt his Canadian workers, and the government says he broke his promises.[11] But his question is the right one. Venezuela's steel output peaked at about five million tonnes in 2007 and has since dwindled to almost nothing.[14] Once a state learns it can threaten, lend to, take stakes in and possibly seize a private company, every owner in the country is on notice.

So-Called Universal Healthcare: Canada vs. the United States

Every Canadian is told the same story: we have universal care, Americans go bankrupt. I want to check that story against the numbers, honestly, including where America does worse.

Waiting to see a specialist

THE QUEUE

Canada ranked last of 10 countries on timeliness.

Waited two months or longer for a specialist (2023)

CanadaUnited StatesWaited 2+ months47%US: [Needs source]

Canada, median weeks (Fraser Institute)

GP to specialist15.3 weeksSpecialist to treatment13.3 weeksTotal, 202528.6 weeksTotal, 19939.3 weeks

47%

of Canadians needing a specialist waited 2+ months (Commonwealth Fund 2023)

Chart: In the Commonwealth Fund's 2023 survey, 47% of Canadians who needed a specialist waited two months or longer, the worst of 10 countries.[31] [Needs source: the US figure from the same survey; I couldn't verify it from a primary table.] Fraser Institute medians come from its physician survey.[4] That is half a year in line before treatment, triple the 1993 wait, in a system where the Canada Health Act penalizes provinces that allow extra billing or user charges for insured care, closing the paid fast lane.[2]

Prescription drug prices, US = 100

DRUGS

Cheaper than America. Still mostly not covered.

All drugs44100Brand-name31100Generics256100CanadaUnited States = 100

44

Canadian price index for all drugs vs the US at 100 (RAND, 2022 data)

Chart: RAND's 2022-data comparison found US prices were 229% of Canadian prices across all drugs, 324% for brand-name drugs, and 39% for unbranded generics. I converted those to an index with the US at 100.[32] Here Canada genuinely beats the US on price, and I won't pretend otherwise. But the "universal" system mostly doesn't pay for them: public programs cover less than 40% of Canada's pharmaceutical costs, and drugs are the biggest item in Canadians' out-of-pocket spending.[33] Generics actually cost Canadians about 2.6 times what Americans pay.

Who pays: Canada vs. the United States

WHO PAYS

"Free" at the counter. Paid at tax time.

Canada, 2025 (CIHI)71.2%28.8%■ Public (taxes)■ Private insurance + out of pocketUnited States, 2024 (CMS)21%18%31%11%19%■ Medicare■ Medicaid■ Private insurance■ Out of pocket■ OtherWhat's coveredCanadaUnited StatesDoctor & hospital visitsFree at point of service, tax-fundedMedicare (65+), Medicaid (lowincome), ACA plans subsidizedon a sliding scale, employerinsurancePrescription drugsNot covered by the CanadaHealth Act; provincial plans,private insurance or cash.Pharmacare Act (2024) startswith contraception anddiabetesInsurance plans with copays;Medicare Part DDental & visionLargely not coveredLargely separate insurance

$19,060

Fraser Institute estimate of what an average Canadian family of four pays in taxes for public health care in 2025

Chart: Canada's split from CIHI's 2025 estimates; CIHI describes the private share as roughly half out-of-pocket and half private insurance.[3][34] US shares of 2024 national health spending from CMS (Medicare 21%, Medicaid 18%, private insurance 31%, out of pocket 11%; "other" is my remainder of the published shares).[35] Coverage: Canada Health Act,[2] Pharmacare Act,[36] US Medicare[37] and ACA income-based subsidies.[38] Canadian care isn't free. It's sliding-scale only in the sense that taxes are: you pay whether you use it or not, scaled to income: about $19,060 in 2025 for an average family of four, $702 for the lowest-income tenth of families, and $58,853 for the top tenth.[39] Then you pay again, privately, for drugs, teeth and eyes.

So here is my scorecard. On drug prices, Canada wins, though most of those drugs sit outside the "universal" plan. On waiting, Canada loses badly, and the law is built to stop Canadians paying their way out of the public queue. That is the real trade: not free care, but state-controlled care, rationed by time.

What's your recourse?

So the public system says no, or says wait. What can you do? In Ontario, if the ministry refuses to fund treatment abroad, you can ask for an internal review or appeal to the Health Services Appeal and Review Board within 30 days.[40] The board can only apply the Health Insurance Act. It "cannot take into account compassionate reasons."[41] You can also complain to the provincial Ombudsman about OHIP decisions.[42] What you largely cannot do is pay to jump the line at home. The Canada Health Act penalizes provinces that allow extra billing or user charges for insured services.[2] British Columbia's Medicare Protection Act bans private insurance for services the public plan covers.[44]

In 2005 the Supreme Court struck down Quebec's ban on private insurance, with Chief Justice McLachlin writing that "access to a waiting list is not access to health care."[43] But in the Cambie Surgeries case, the B.C. courts upheld that province's restrictions, even while the Court of Appeal accepted that they deprive some patients of their right to life and security of the person. In April 2023 the Supreme Court refused to hear the appeal.[44][45] So your options are to wait, to appeal under rules that ignore compassion, or to go to the United States and pay.

It's a cage of control. If the government says you're done treating, you're done treating. The government controls, not you.

MAID: the health system offers death

Single-payer healthcare means the state decides what care you get and how long you wait. Since 2016 it has also offered something else. Bill C-14 legalized medical assistance in dying for people whose natural death was "reasonably foreseeable." In 2021, Bill C-7 removed that requirement and created a second track for people who are not dying.[15] Eligibility for people whose only condition is a mental illness has been postponed twice, now to 17 March 2027.[16]

Medically assisted deaths in Canada, by year

MAID

One in twenty deaths in Canada is now arranged by the health system.

Medically assisted deaths in Canada by yearMAID provisions in Canada: 2016: 1,018; 2017: 2,838; 2018: 4,493; 2019: 5,461 (2.0% of deaths); 2020: 7,469 (2.5% of deaths); 2021: 10,066 (3.3% of deaths); 2022: 13,199 (4.1% of deaths); 2023: 15,427 (4.7% of deaths); 2024: 16,499 (5.1% of deaths)05,00010,00015,0001,0182016n/a2,8382017n/a4,4932018n/a5,46120192.0%7,46920202.5%10,06620213.3%13,19920224.1%15,42720234.7%16,49920245.1%% of deathsYear (2016 = June–December only)

76,475

MAID deaths since legalization in 2016; 16,499 in 2024 alone, 5.1% of all deaths

Chart: MAID provisions per year from Health Canada's Sixth Annual Report (2024), which revises earlier years (for example, 2023 was first reported as 15,343).[18] Share of all deaths for 2019–2024 from Health Canada's annual reports.[18][19][20] Health Canada says the 2024 share may change once Statistics Canada finalizes death counts. [Needs source: share of all deaths for 2016–2018; 2016–2018 counts as restated in the 2024 report's historical tables.]

Nobody in Canada is legally forced to die, and I won't claim otherwise. What I see is pressure and a lack of alternatives. In 2022 the Veterans Affairs minister told MPs that one caseworker had raised MAID with as many as four veterans, and those cases were referred to the RCMP.[21] Retired corporal and Paralympian Christine Gauthier testified that a Veterans Affairs employee offered her MAID during her long fight for a wheelchair ramp. The department said its review of her file did not corroborate her account.[21][22]

Ontario's own MAID Death Review Committee describes "Ms. B," a woman in her 50s with multiple chemical sensitivities. After years of failing to find housing she could live in, her remaining option was a small hypoallergenic "bubble." The isolation "greatly contributed to her suffering and request for MAiD."[23] The committee found that Track 2 recipients were more likely than Track 1 recipients to live in the areas with the most material deprivation (28.4% vs. 21.5%)[23], and far more likely to cite isolation or loneliness (39.7% vs. 15.8%).[24] When a person can get a lethal injection faster than a home, that is not free choice. It is a system that ran out of answers.

Then there is how it is done. In 2023, London, Ontario family doctor James MacLean assessed Thomas Dillon, 45, who had inflammatory bowel disease and a history of mental illness, outside a Tim Hortons in St. Thomas. On 29 January 2024 he met Dillon at the Tim Hortons again and drove him to an industrial unit in London where bodies are prepared for funeral homes, and there ended his life.[17][25] Ontario's medical regulator found he had crossed professional boundaries in a way that "risked looking like coercion." It gave him a caution, not discipline, plus six months of supervision.[25][26] To me, that is what "care" looks like when the state is the only provider: you may wait half a year for surgery,[4] but your death can be arranged at a Tim Hortons, with the doctor driving you to an industrial unit to die.

Who pays, and who saves. MAID is billed like any other insured service. In Ontario, a MAID eligibility consultation (fee code A320) pays $174.25 for at least 50 minutes with the patient, and "MAID Support" (K321) pays $85.25 per half hour. That covers everything up to and including giving the drugs, pronouncing death and calling the coroner, and up to two physicians can bill it.[27][28] British Columbia has its own MAiD fee codes for assessments and for the procedure.[29] [Needs source: current BC dollar amounts, Alberta MAID fees, and total or per-case provider earnings.] As for the system as a whole, in 2020 the Parliamentary Budget Officer estimated that MAID would cut provincial health costs by a net $149 million in 2021, $62 million of it from C-7's expansion.[30] The PBO called that negligible. I call it the system saving money when people die sooner.

My view

None of this happened at once. Canada built it one sensible-sounding step at a time: universal care, a national post office, a public broadcaster, an emergency loan, a binding undertaking, a stake. Add them up and the government spends close to half of GDP[1] and decides how long you wait for surgery. It funds the newsroom that covers it. Increasingly, it also decides whether a steel mill keeps its owner. To me, that is not a market economy with a safety net. It is a cage with a market painted on the bars.

Sources

  1. IMF DataMapper, "Government expenditure, percent of GDP" (Public Finances in Modern History), Canada — https://www.imf.org/external/datamapper/exp@FPP/CAN
  2. Canada Health Act (R.S.C. 1985, c. C-6) — https://laws-lois.justice.gc.ca/eng/acts/c-6/
  3. CIHI, National health expenditure trends, 2025 — https://www.cihi.ca/en/national-health-expenditure-trends
  4. Fraser Institute, "Waiting Your Turn: Wait Times for Health Care in Canada, 2025 Report" (9 Dec 2025) — https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
  5. Canada Post, "Canada Post reports $1.57 billion loss before tax for 2025" (20 Apr 2026) and 2025 Annual Report — https://www.canadapost-postescanada.ca/cpc/en/our-company/news-and-media/corporate-news/news-release/2026-04-20-canada-post-reports-157-billion-loss-before-tax-for-2025
  6. CBC News, "Carney pledges $150M boost to 'underfunded' CBC" — https://www.cbc.ca/news/politics/mark-carney-cbc-funding-1.7501902
  7. Canada Enterprise Emergency Funding Corporation, September 29, 2025 announcement — https://ceefc-cfuec.ca/september-29-2025/
  8. Algoma Steel, "Algoma Steel Completes $500 Million Government Financing Transaction" (17 Nov 2025) — https://ir.algoma.com/news-releases/news-release-details/algoma-steel-completes-500-million-government-financing
  9. Department of Finance Canada, "Government of Canada acts to protect Canadian steel jobs, announces support to an industry leader" (Sep 2025) — https://www.canada.ca/en/department-finance/news/2025/09/government-of-canada-acts-to-protect-canadian-steel-jobs-announces-support-to-an-industry-leader.html
  10. The Globe and Mail (Niall McGee), "Cleveland-Cliffs boss dismisses idea of nationalizing Stelco as Ottawa pushes to preserve jobs" (7 Oct 2026) — https://www.theglobeandmail.com/business/article-cleveland-cliffs-dismisses-nationalizing-stelco-ottawa-jobs/
  11. Global News, "Stelco penalties including fines, forced sale possible over layoffs: Joly" — https://globalnews.ca/news/12101944/stelco-federal-government-legal-action/
  12. Reuters via Yahoo Finance, "Canada exploring Stelco nationalization, industry minister says" (16 Oct 2026) — https://ca.finance.yahoo.com/news/canada-exploring-stelco-nationalization-industry-180230262.html
  13. Toronto Star, "Stelco may be forced to sell Canadian assets if layoffs aren't rescinded — and Ottawa could take a stake: Joly" (16 Oct 2026) — https://www.thestar.com/business/feds-will-force-sale-of-stelco-s-canadian-assets-if-layoffs-aren-t-rescinded-and-ottawa-could-take-a-stake-joly/article_d9ca4836-49e9-40e3-b8aa-561d8faf6edf.html
  14. SteelOrbis, "The collapse of the steel production chain in Venezuela" (3 Feb 2026) — https://www.steelorbis.com/steel-news/latest-news/the-collapse-of-the-steel-production-chain-in-venezuela-1433496.htm
  15. Health Canada, "Medical assistance in dying: Legislation in Canada" — https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying/legislation-canada.html
  16. Bill C-62, S.C. 2024, c. 1 (royal assent 29 Feb 2024) — https://laws.justice.gc.ca/PDF/2024_1.pdf
  17. The Globe and Mail, "Ontario doctor cautioned over MAID complaints can continue practice under supervision, regulator rules" (25 May 2026) — https://www.theglobeandmail.com/canada/article-ontario-doctor-maid-complaints-supervision-regulator/
  18. Health Canada, Sixth Annual Report on Medical Assistance in Dying in Canada (2024) — https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2024.html
  19. Health Canada, Medical Assistance in Dying in Canada 2023 — https://www.canada.ca/content/dam/hc-sc/documents/services/publications/health-system-services/annual-report-medical-assistance-dying-2023/annual-report-medical-assistance-dying-2023.pdf
  20. Health Canada, Medical Assistance in Dying in Canada 2022 — https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying/annual-report-2022/annual-report-2022.pdf
  21. CBC News, "Former paralympian tells MPs veterans department offered her assisted death" (Dec 2022) — https://www.cbc.ca/news/politics/christine-gauthier-assisted-death-macaulay-1.6671721
  22. Global News, "Veterans affairs minister says no more assisted dying cases found despite new claims" — https://globalnews.ca/news/9326699/veterans-assisted-dying-gauthier-minister/
  23. Office of the Chief Coroner for Ontario, MAiD Death Review Committee Report 2024-3 (Track 2 and vulnerability) — https://s3.documentcloud.org/documents/25238359/canada-euthanasia-3.pdf
  24. Office of the Chief Coroner for Ontario, MAiD Death Review Committee Report 2024-2 (Track 2 complex conditions) — https://arpacanada.ca/wp-content/uploads/2024/10/2024.2_-NRFND-Complex-Conditions_Final-Report.pdf
  25. The Globe and Mail, "Experts split on MAID oversight after Ontario lets disciplined doctor continue practice" (28 May 2026) — https://www.theglobeandmail.com/canada/article-case-of-disciplined-maid-doctor-divides-experts-reflecting-gulf-in/
  26. National Post, "Ontario man dies of MAID after being assessed outside Tim Hortons" — https://nationalpost.com/news/ontario-man-dies-of-maid-after-being-assessed-outside-tim-hortons
  27. Ontario Medical Association, MAID Billing Guide (v10, 10 Jul 2026, reflecting the 1 Apr 2026 OHIP Schedule of Benefits) — https://www.oma.org/siteassets/oma/media/pagetree/pps/billing/ohip/maid-billing-guide---combined.pdf
  28. Famy Billing, "MOH Schedule of Benefits 2026 — New Family Medicine Codes" (A320/C320/K321 fee values) — https://www.famybilling.com/assets/pdfs/famy-billing-moh-sob-family-medicine-newcodes-2026-v2.pdf
  29. Government of British Columbia, "Medical Assistance in Dying — Information for Health-Care Providers" (MSP fee codes P13501–P13508) — https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/medical-assistance-in-dying/information-for-providers
  30. Office of the Parliamentary Budget Officer, "Cost Estimate for Bill C-7 'Medical Assistance in Dying'" (20 Oct 2020) — https://www.pbo-dpb.ca/en/publications/RP-2021-025-M--cost-estimate-bill-c-7-medical-assistance-in-dying--estimation-couts-projet-loi-c-7-aide-medicale-mourir
  31. C.D. Howe Institute (Tingting Zhang), "Troubling Diagnosis: Comparing Canada's Healthcare with International Peers" (14 Jan 2025) — https://cdhowe.org/publication/troubling-diagnosis-comparing-canadas-healthcare-with-international-peers/
  32. RAND (Mulcahy et al.), "International Prescription Drug Price Comparisons: Estimates Using 2022 Data" (2024) — https://www.rand.org/pubs/periodicals/health-quarterly/issues/v11/n3/05.html
  33. C.D. Howe Institute, "Troubling Diagnosis" — out-of-pocket spending breakdown (pharmaceuticals 41%), citing OECD Health at a Glance 2023 — https://cdhowe.org/publication/troubling-diagnosis-comparing-canadas-healthcare-with-international-peers/
  34. CIHI, Health Expenditure Data in Brief 2025 and "More Than Money" webinar — https://www.cihi.ca/sites/default/files/document/health-expenditure-data-in-brief-2025-en.pdf
  35. CMS, National Health Expenditure Fact Sheet (2024 data) — https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
  36. Health Canada, "Government of Canada Passes Legislation for a First Phase of National Universal Pharmacare" (Oct 2024) — https://www.canada.ca/en/health-canada/news/2024/10/government-of-canada-passes-legislation-for-a-first-phase-of-national-universal-pharmacare.html
  37. Medicare.gov, "Get started with Medicare" — https://www.medicare.gov/basics/get-started-with-medicare
  38. HealthCare.gov, "Lower costs" (income-based savings on Marketplace plans) — https://www.healthcare.gov/lower-costs/
  39. Fraser Institute, "The Price of Public Health Care Insurance, 2025" (9 Sep 2025) — https://www.fraserinstitute.org/studies/price-public-health-care-insurance-2025
  40. Government of Ontario, "OHIP coverage while outside Canada" — https://www.ontario.ca/page/ohip-coverage-while-outside-canada
  41. Health Services Appeal and Review Board (Ontario), Frequently Asked Questions — https://www.hsarb.on.ca/scripts/english/faq.asp
  42. Ombudsman Ontario, "Help with OHIP, Drug Funding & Assistive Devices" — https://www.ombudsman.on.ca/en/make-complaint/what-we-can-help-you/health
  43. Supreme Court of Canada, Chaoulli v. Quebec (Attorney General), 2005 SCC 35 — https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/2237/index.do
  44. Court of Appeal for British Columbia, Cambie Surgeries Corporation v. British Columbia (Attorney General), 2022 BCCA 245; SCC docket 40412 summary — https://www.scc-csc.ca/cases-dossiers/search-recherche/40412/
  45. Health Canada, Statement from the Minister of Health on the Supreme Court of Canada's decision in the Cambie Surgeries case (6 Apr 2023) — https://www.canada.ca/en/health-canada/news/2023/04/statement-from-the-minister-of-health-on-the-supreme-court-of-canadas-decision-in-the-cambie-surgeries-case.html